Working with young people in rural areas? This fact sheet provides guidance based on available evidence on engaging and supporting young people in rural and regional areas. Get information on the unique characteristics of rural communities, guidance on addressing the stigma of mental illness, and our top recommendations for working with rural young people.
This will help you to:
- understand the differences in support work in rural areas
- understand what stigma looks like in rural areas
- provide context appropriate support
Characteristics of rural communities
There are two aspects of working with young people in rural areas that are important for professionals to keep in mind. First, access to services in rural areas - particularly specialist mental health care - is limited, and this has implications for young people with mental health problems2. For instance, young people may either be uncertain as to whether help is available in their town or they may have to travel great distance to access quality care1.
They may also be reluctant to seek care because of a perception that the services available in their town are not youth-friendly4,7.
While there may be a GP in town, it is likely that the GP is an older and established member of the community, making him or her less likely to be considered by young people as approachable4. As public transport in rural areas is scarce, the need to travel to services outside of the town is a threat to the young person's anonymity and confidentiality if he or she is not licensed to drive a car2.
The second aspect of working with young people in rural areas may be less obvious but in many ways is more important - the social characteristics of rural communities3. Several researchers have described rural communities as socially proximate or close-knit8. A paradox exists between the closeness of social relationships in rural communities and the distance that separate community members.
Members of rural communities can often possess intimate knowledge of each other's lives and this makes it very difficult for rural youth to keep personal information quiet. Social visibility and rural gossip networks mean that a young person needing to access mental health services might fear being seen as well as fear being talked about1. Young people who seek help in rural areas may also experience stigma and social exclusion1.
Stigma of mental illness
There are two forms of stigma of mental illness - social stigma and self-stigma6. While social stigma is imposed by the community, self-stigma is a judgement imposed on a person with mental illness by themselves, as an internalisation of community attitudes.
In small rural communities there is often a 'culture of self-reliance' which means that community members are expected to 'soldier-on' and not talk about their problems to anyone8. Stoic attitudes among rural men are the norm, and mental illness can be considered a sign of weakness7. As such, the experience of self-stigma for a young person in a rural area can be particularly profound, especially for males3.
All young people with mental health problems are at risk of experiencing social stigma of mental illness. In small rural communities, however, this experience is exacerbated by the social characteristics of rural communities1. Members of a close-knit community typically engage in a range of caring practices if a fellow community member experiences a physical illness; however, these same caring practices may not extend to a person with a mental illness9.
Therefore, a young person with a mental health problem can experience feelings of rejection and isolation, ostracism or exclusion when the usual caring practices of the community are not forthcoming1,4. Furthermore, stigmatisation in rural communities can be seen to serve a social distancing function whereby community members limit their social obligations to people with mental illness in a context where access to services is poor5.
Recommendations for working with rural young people
With an awareness and appreciation of the characteristics of rural communities, we recommended that professionals working with young people in rural areas do the following, in addition to their usual practice:
- Talk to young people about their experiences of accessing the service, e.g., what obstacles did they experience in their pathway to care?
- Consider whether these obstacles are likely to have an on-going impact on the young person's care and think of ways that they might be minimised
- Explicitly raise and discuss the young person experiences of social stigma and self-stigma as well as the culture of self-reliance in rural communities
- Explain the notion of social proximity - i.e., "everybody knows everybody else" - and the phenomenon of rural gossip as a consequence of social proximity. Discuss feelings of rejection or social exclusion associated with these phenomena
- Give the young person strategies to cope with negative community attitudes
- Help the young person identify sources of social support within their community
- Assist the young person, over the course of the therapeutic interaction, to develop a strong sense of self and to reject self-stigma.
- Aisbett, D.L., Boyd, C.P., Francis, K., Newnham, K., & Newnham, K. (2007). Understanding the barriers to mental health service utilization for adolescents in rural Australia. Rural and Remote Health, 7 (online), no. 624.
- Boyd, C.P., Aisbett, D.L., Francis, K., Newnham, K., & Newnham, K. (2006). Issues in rural adolescent mental health in Australia. Rural and Remote Health, 6 (online), no. 501.
- Boyd, C.P., Hayes, L., Sewell, J., Caldwell, K., Kemp, E., Harvie, L., Aisbett, D.L., & Nurse, S. (2008). Mental health problems in rural contexts: A broader perspective. Australian Psychologist, 43, 2-6.
- Boyd, C.P, Francis, K., Aisbett, D.L., Newnham, K., Sewell, J., Dawes, G., & Nurse, S. (2007). Australian rural adolescents' experiences of accessing psychological help for a mental health problem. Australian Journal of Rural Health, 15, 196-200.
- Boyd, C.P., & Parr, H. (2008). Social geography and rural mental health research. Rural and Remote Health, 8 (online), no. 804.
- Corrigan, P.W. (2005). On the stigma of mental illness. Washington, DC: American Psychological Association.
- Francis, K., Boyd, C.P., Aisbett, D.L., Newnham, K., & Newnhmam, K. (2006). Rural adolescents' perceptions of barriers to seeking help for mental health problems. Youth Studies Australia, 25, 42-49.
- Parr, H., & Philo, C. Rural mental health and social geographies of caring. Social and Cultural Geography, 4, 471-488.
- Parr, H., Philo, C., & Burns, N. (2004). Social geographies of rural mental health: Experiencing inclusion and exclusion. Transactions of the Institute of British Geographers, 29, 401-419.